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Income and Resource Limits for New York State Public Health Insurance Programs

Click here for NYS Medicaid Income and Resource Levels Chart for 2017 (NYC Human Resources Administration publishes chart annually based on NYS Dept. of Health figures). Chart shows income and resource limits for Medicaid and other public health insurance programs in New York State, including the Medicare Savings Program and MBI-WPD . It shows MAGI and NON-MAGI income limits.

State directive with these figures are:

Which household size applies? The rules are complicated. See rules here.

Box 2 is NON-MAGIIncome and Resource levels — Age 65+, Blind or Disabled and other adults who need to use ” spend-down ” because they are over the MAGI income levels.

Box 10 on page 3 are the MAGIincome levels — The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers. P eople in the “MAGI” category – those NOT on Medicare — have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a “spend-down.” They have NO resource limit.

Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility

Box 4 are Medicare Savings Program levels now updated for 2017

Box 6 has Medicaid Buy-In for Working People with Disabilities Under Age 65 now updated in 2017

This short summary chart shows that income limits have increased for the new “MAGI” category created by the Affordable Care Act, but not for the “Non-MAGI” population – the Disabled, Aged 65+ and Blind ( DAB ).

Disabled, 65+ or Blind (“DAB” or SSI-Related ) and have Medicare

NOTE: MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R. В§ 435.4.

Certain populations have an even higher income limit –

CAUTION: What is counted as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population – which is virtually everyone under age 65 who is not on Medicare – their income will now be determined under new rules, based on federal income tax concepts – called “Modifed Adjusted Gross Income” (MAGI). There are good changes and bad changes.

GOOD: Veteran’s benefits, Workers compensation, and gifts from family or others no longer count as income. BAD: There is no more “spousal” or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For all of the rules see:

HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES

The income limits increase with the “household size.” In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the “category” of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size.

People who are Disabled, Aged 65+ or Blind – “DAB” or “SSI-Related” Category — NON-MAGI – See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article.

Everyone else — MAGI – All children and adults under age 65, including people with disabilities who are not yet on Medicare — this is the new “MAGI” population. Their household size will be determined using federal income tax rules, which are very complicated.

New rule is explained in State’s directive 13 ADM-03 – Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49. Also see Legal Aid Society and Empire Justice Center materials

OLD RULE used until end of 2013 — Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA , ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st “DAB” category. Under this rule, a child may be excluded from the household if that child’s income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007

CAUTION: Different people in the same household may be in different “categories” and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband’s household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife’s is under Category 2/MAGI.

The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid:

Prenatal Care Assistance Program ( PCAP ) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL).

Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as “S/CC” category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow “spend down” of excess income . This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL.

Family Health Plus – this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL. For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange.

PAST INCOME RESOURCE LEVELS —

Past Medicaid income and resource levels in NYS are shown on these old NYC HRA charts for 2001 through 2016, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

Who Qualifies for Coverage?

Depending on a number of factors an individual may qualify for full Mississippi Medicaid health benefits, reduced coverage or limited benefits (full coverage with some service limits) in a covered group briefly described below.

Full Medicaid Benefits

The following covered groups of people qualify for full Mississippi Medicaid health benefits if eligible under the appropriate income limits and other qualifications.

Covered group: infants and children

Age: up to 19 (0-18)

Qualifications: Household income, tax filing status and the relationships between household members must be considered in determining eligibility for each infant and child living in the home.

Covered group: uninsured children

Income limits: based on age, insured status of each child, family size and family household income cannot exceed 209% of the federal poverty level (FPL) (refer to the MAGI income limit table)

Age: up to 19 (0-18)

Qualifications: A child must be determined ineligible for Medicaid before eligibility for CHIP can be considered. Children with current health insurance coverage at the time of application are not eligible for CHIP. The child’s age and family income factor into when a child may qualify for CHIP.

Covered group: low-income parents, caretakers

Qualifications: Parents or caretakers must have children under age 18 living in the home, who are deprived of the support of one or both parents due to the disability of a parent, the death or continued absence of a parent or have parent(s) who are unemployed or have very low income. Caretaker relatives must be within a certain degree of relationship to the children and have primary responsibility for children under age 18 in order to qualify. As a condition of eligibility, the adult must cooperate with child support enforcement requirements for each child deprived due to a parent s continued absence from the home.

Covered group: pregnant women

Qualifications: Pregnant women receive benefits two months postpartum and are automatically put on the family planning waiver for one year. Any child born to Medicaid eligible mother automatically receives Medicaid benefits until the infant reaches the age of one. The number of individuals within the family is increased by the number of babies expected when determining family size for Medicaid. Pregnant minors (under age 19) can qualify regardless of family income.

Covered group: disabled children who require a level of care typically provided in a hospital or long term care facility

Income limits: Only the child’s income and resources are considered. The limit is the current institutional maximum income limit and the resource limit is $2,000. For more information, view the Guidelines for Medicaid Eligibility for Disabled Child Living At Home brochure.

Age: up to 19 years old (0-18)

Qualifications: The child must be disabled and in need of an institutional level of care.

Covered group: working disabled

Income limits: income cannot exceed 250% of the federal poverty level and unearned income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Persons Working and Disabled brochure.

Age: no age restrictions, but individuals age 65 or over must be disabled

Qualifications: The working disabled individual must work at least 40 hours per month. Those who earn more than 150% of the federal poverty level must pay a monthly premium to purchase Medicaid coverage.

Covered group: aged, blind or disabled (eligibility for this covered group is certified by the Social Security Administration

Age: 65 or older; if under age 65 must be blind or disabled

Qualifications: Individuals must be blind or disabled or age 65 or older. SSI recipients are automatically eligible for Medicaid.

Covered group: Certain Former SSI Recipients who lose SSI due to a qualifying event that allows Medicaid to continue. This category includes certain disabled adult children, widow(er)s within a certain age limit who do not have Medicare and certain individuals who lose SSI due to a cost of living increase in their Social Security benefits. For more information, view the Guidelines for the Aged, Blind and Disabled Receiving SSI or Former SSI Recipients brochure.

Covered group: Aged 65 or over or under age 65 who are blind or disabled. The individual must be determined to be in need of a level of care that is provided by the nursing facility or HCBS waiver program.

Income limits: monthly income that does not exceed 300% of the SSI Federal Benefit Rate. Individuals whose income exceeds the institutional limit may qualify based on an Income Trust that obligates all income to the facility or to the Division of Medicaid. For HCBS waiver participants, income over the Medicaid limit is payable to the Division of Medicaid under the terms of an Income Trust. For more information, view the Guidelines for Medicaid Eligibility for Aged, Blind and Disabled Living in Nursing Homes brochure.

Qualifications: Placement in a facility or HCBS waiver program must be medically necessary and the individual must be income and resource eligible and must not have transferred assets within a five year look back period and any subsequent months in order to qualify for Medicaid.

Covered group: non-qualified or undocumented immigrants

Income limits: An immigrant must qualify for a covered group on all factors other than citizenship and immigration status. The income (and resource) limit for the covered group applies.

Age: The age limit for the applicable covered group applies.

Qualifications: Immigrants who have had an emergency medical service and who are determined eligible for a covered group, are covered solely for the date of service of the emergency.

Reduced Coverage / Medicare Cost Sharing or Premium Payment

Covered group: individuals covered by Medicare

Age: Medicare beneficiaries of any age

Qualifications: Individuals must be eligible for Medicare Part A hospital insurance.

Covered group: individuals covered by Medicare

Age: Medicare beneficiaries of any age

Qualifications: Individuals must have Medicare Part A (hospital insurance)

Covered group: individuals covered by Medicare

Age: Medicare beneficiaries of any age

Qualifications: Individuals must have Medicare Part A (hospital insurance)

Limited Benefits

Covered group: women and men

Income limits: family income at or below 194% FPL

Age: 13-44 years old

Qualifications: This Waiver will cover women and men who have not had any type of procedure that would prevent them from reproducing, and does not have any other type of health insurance.

Covered group: aged, blind or disabled who are not Medicare eligible

Age: 65 or older, blind or disabled

Qualifications: This waiver covers individuals who are not eligible for Medicare. Once Medicare starts, eligibility for the Healthier MS Waiver ends.

Income and Resource Limits for New York State Public Health Insurance Programs

Click here for NYS Medicaid Income and Resource Levels Chart for 2017 (NYC Human Resources Administration publishes chart annually based on NYS Dept. of Health figures). Chart shows income and resource limits for Medicaid and other public health insurance programs in New York State, including the Medicare Savings Program and MBI-WPD . It shows MAGI and NON-MAGI income limits.

State directive with these figures are:

Which household size applies? The rules are complicated. See rules here.

Box 2 is NON-MAGIIncome and Resource levels — Age 65+, Blind or Disabled and other adults who need to use ” spend-down ” because they are over the MAGI income levels.

Box 10 on page 3 are the MAGIincome levels — The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers. P eople in the “MAGI” category – those NOT on Medicare — have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a “spend-down.” They have NO resource limit.

Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility

Box 4 are Medicare Savings Program levels now updated for 2017

Box 6 has Medicaid Buy-In for Working People with Disabilities Under Age 65 now updated in 2017

This short summary chart shows that income limits have increased for the new “MAGI” category created by the Affordable Care Act, but not for the “Non-MAGI” population – the Disabled, Aged 65+ and Blind ( DAB ).

Disabled, 65+ or Blind (“DAB” or SSI-Related ) and have Medicare

NOTE: MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R. В§ 435.4.

Certain populations have an even higher income limit –

CAUTION: What is counted as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population – which is virtually everyone under age 65 who is not on Medicare – their income will now be determined under new rules, based on federal income tax concepts – called “Modifed Adjusted Gross Income” (MAGI). There are good changes and bad changes.

GOOD: Veteran’s benefits, Workers compensation, and gifts from family or others no longer count as income. BAD: There is no more “spousal” or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For all of the rules see:

HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES

The income limits increase with the “household size.” In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the “category” of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size.

People who are Disabled, Aged 65+ or Blind – “DAB” or “SSI-Related” Category — NON-MAGI – See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article.

Everyone else — MAGI – All children and adults under age 65, including people with disabilities who are not yet on Medicare — this is the new “MAGI” population. Their household size will be determined using federal income tax rules, which are very complicated.

New rule is explained in State’s directive 13 ADM-03 – Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49. Also see Legal Aid Society and Empire Justice Center materials

OLD RULE used until end of 2013 — Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA , ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st “DAB” category. Under this rule, a child may be excluded from the household if that child’s income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007

CAUTION: Different people in the same household may be in different “categories” and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband’s household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife’s is under Category 2/MAGI.

The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid:

Prenatal Care Assistance Program ( PCAP ) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL).

Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as “S/CC” category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow “spend down” of excess income . This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL.

Family Health Plus – this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL. For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange.

PAST INCOME RESOURCE LEVELS —

Past Medicaid income and resource levels in NYS are shown on these old NYC HRA charts for 2001 through 2016, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

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MDHHS

Assistance Programs

Medicaid

Essential health care coverage, such as Medical Assistance or Medicaid, is available to those who otherwise cannot afford it. Michigan has many health care programs available to children, families and adults who meet eligibility requirements. Each program has income limits and some have an asset limit – limits vary with each program.

Once you have been determined eligible for Medicaid you will receive a mihealth card. Each member of the family receives his or her own card. Most people who receive Medicaid must join a health plan. You will need to show your mihealth card and your health plan card when you receive medical services.

Do not throw this card away. If your mihealth card is lost, stolen or damaged, call 800-642-3195.

Michigan Medicaid Health Plans

Member and provider access to information on drugs and supplies covered by the Michigan Medicaid Health Plans.

Medicaid Health Plan Contact and County Service Listing List of Medicaid health plans showing Michigan counties in which each the health plan operates.

Health Plan Enrollment

This page contains Medicaid and Healthy Michigan Plan Health Plan enrollment figures by county for the current and previous months for each of the Health Plans.

Medicaid Health Plan Performance Reports

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a set of survey tools developed to assess patient satisfaction with their health plan.

The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of performance data developed and maintained by the National Committee for Quality Assurance (NCQA), and is the most widely used standardized performance measure in the managed care industry.

Medicaid for the Elderly, Blind, or Disabled

Announcements

Wisconsin’s ForwardHealth Medicaid plans for the elderly, blind or disabled provide health care for those who are:

Age 65 or older, blind or disabled,

With family income at or below the monthly program limit, and

Who are U.S. citizens or legal immigrants.

The type of Medicaid plan or program you may be eligible for depends on your income, assets, and type of care you need.

Learn more about how the Medicaid Purchase Plan (MAPP) program is helping those with disabilities to live independent lives.

Programs

Community Waivers help elderly, blind or disabled people live in their own homes or in the community, rather than a state institution or a nursing home.

Emergency Services Plan only covers medical services needed for the treatment of an emergency medical condition for documented and undocumented non-citizens.

Family Care is a long term care program for groups who are elderly, people with physical disabilities or with developmental disabilities.

Medicaid Deductible plan can help if you have high medical bills and your income is over the Medicaid program income limits.

Medicaid Purchase Plan provides health care for people with disabilities who work.

Medicare Savings Programs (also called Medicare Premium Assistance) can help some people pay their Medicare Part A and B premiums, coinsurance and deductibles.

Well Woman Medicaid Plan helps women who have been diagnosed with and are in need of treatment for breast and cervical cancer.

Other Health Care Programs

If you are not elderly, blind or disabled, and you are in need of health care coverage, you may be able to enroll in a BadgerCare Plus, including Family Planning Only Services and BadgerCare Plus Prenatal Services. For more information call Member Services at 1-800-362-3002.

To see what programs you may be able to enroll in, visit ACCESS.wi.gov and click on “Am I Eligible?” or go directly to “Apply for Benefits.”

Other Information

Estate Recovery Program

The Estate Recovery Program provides information about which members and programs are affected, how the recovery of an estate is made in order to collect repayment for certain services, and situations where repayment may not be recovered from an estate.

Find Help in Your Area

Medicaid contacts.

Call Member Services at 1-800-362-3002 to contact a Disability Benefit Specialist or Elder Benefit Specialist at your local Aging and Disability Resource Center (ADRC) or County Aging Office.

Be Aware of Phone Scams

If you are getting health care benefits, DHS will not call you seeking personal or financial information. If you are getting FoodShare benefits, your agency will call you to complete a FoodShare interview and may ask you to verify certain information to ensure they are talking with the correct person. If you are unsure of who you are talking to, hang up, and call your agency or Member Services at 1-800-362-3002.

The Federal Trade Commission (FTC), the nation’s consumer protection agency, advises consumers not to give out personal or financial information to people you do not know through phone calls, emails, or knocks on your door. Scam artists want your information to commit identity theft, charge your existing credit cards, debit your checking account, open a new credit card, checking, or savings account, write fraudulent checks, or take out loans in your name.

To file a complaint with the FTC, go to their website, or call 1-877-FTC-HELP. If you think your identity has been stolen, report it on the FTC’s website, or call 1-877-ID-THEFT.

Medicaid Gross Income and Deductions Limits

Medicaid is a state-run program that helps people to afford their medical bills. There is more to determining eligibility for Medicaid than simply a person’s income. Only people with certain circumstances and who meet particular limits for their modified adjusted gross income will qualify for the program. The Affordable Care Act proposes to make amendments to these requirements in 2014.

Gross Income

The limits for an applicant’s gross income and assets are dependent upon the state in which he resides. Each state sets a level for the modified adjusted gross income of a person who wishes to qualify for Medicaid. Your modified adjusted gross income is your adjusted gross income, found on line 38 of Form 1040, plus additions for several tax deductions you previously subtracted to determine adjusted gross income. These deductions include: individual retirement account contributions, tuition and fees deduction, student loan interest deduction, foreign earned income that was excluded, adoption benefits deduction for the amount received from your employer and foreign housing deduction. Once you add these back to your adjusted gross income, you can determine whether you meet the modified adjusted gross income for your state. For many states, the modified adjusted gross income level begins at the federal poverty line.

Assets

In some states the amount of assets you own may affect your eligibility for Medicaid coverage. Assets include any retirement or saving accounts, savings bonds, your home, inheritances and any other type of security or property that could be exchanged for cash. The guidelines for how your assets will affect your eligibility depend on the state in which you reside.

Individual Limits

Individual circumstances aid in determining whether or not you are eligible to receive Medicaid, as it is not solely based on income and assets. Other determinants include whether you are pregnant or have children under the age of 18 who reside at home with you. The children do not necessarily have to be your own. If you are their legal guardian, you may still qualify. If you are over the age of 65, blind, disabled or terminally ill, you may also qualify. If any of the above situations apply and you are either leaving welfare or have existing medical bills you cannot pay, you may be approved as well.

Proposed Changes by the Affordable Care Act

The Affordable Care Act proposes to make changes that affect the eligibility of certain individuals for receiving Medicaid coverage. If put into effect, all individuals from ages 19 to 65 whose income is at or below 133 percent of the federal poverty level for the pertinent year will be eligible to receive Medicaid. The Act will also create a more simplified income test and streamline the enrollment process for applicants while allowing an individual to remain enrolled for up to 12 months if no changes in circumstances occur during that time period. The states will still largely govern and run their Medicaid programs, with the baseline eligilibility requirements set by the federal government. These changes are currently set to take place in 2014.

Medicaid & CHIP coverage

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Some states have expanded their Medicaid programs to cover all people below certain income levels.

See if you qualify for Medicaid based on income alone

Find out if your state is expanding Medicaid and if you qualify based only on your income. We’ll also tell you if you qualify for savings on a health insurance plan instead.

Even if your state hasn’t expanded Medicaid and you don’t qualify based on income alone, you should apply.

Each state has coverage options that could work for you – particularly if you have children, are pregnant, or have a disability.

There’s no limited enrollment period for Medicaid or CHIP. If you qualify, coverage can begin immediately, any time of year.

Apply for Medicaid and CHIP 2 ways

1. Through the Health Insurance Marketplace

Fill out an application through the Health Insurance Marketplace.

If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment.

When you submit your Marketplace application, you’ll also find out if you qualify for an individual insurance plan with savings based on your income instead. Plans may be more affordable than you think.

Start a Marketplace application. Just choose your state, click “Continue,” and select whether you want to use a quick Medicaid/CHIP screener or just start an application.

2. Through your state Medicaid agency

You can also apply directly to your state Medicaid agency. Select your state below for your Medicaid agency’s contact information.

STATE DROPDOWN TOKEN

Medicaid CHIP basics

Medicaid basics

In all states, Medicaid provides coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

In some states, Medicaid has been expanded to cover all adults below a certain income level. Learn more about Medicaid expansion in your state and what it means for you .

Medicaid programs must follow federal guidelines, but coverage and costs may be different from state to state.

In all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women.

Each state works closely with its state Medicaid program.

In many cases, if you qualify for Medicaid your children will qualify for either Medicaid or CHIP.

Learn more about CHIP .

More questions: Medicaid and CHIP

If I have Medicaid or CHIP, am I considered “covered” by the health care law?

Yes. If you have Medicaid or CHIP you don’t have to buy a Marketplace insurance plan. You don’t have to pay the fee that people without health coverage must pay. (Certain limited coverage Medicaid plans, like those that cover only family planning or outpatient hospital services, don’t qualify as coverage under the health care law.) Learn more about limited-coverage Medicaid programs .

What services does Medicaid cover?

Medicaid benefits are different in each state. But all states provide comprehensive coverage. See what services Medicaid offers in all states .

What’s the income level to qualify for Medicaid?

It depends on the state you live in.

If your state has expanded Medicaid: You can qualify based on income alone. See if you’ll qualify. If your state has not expanded Medicaid: You may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors. Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.

If my income’s too high for Medicaid, can I buy insurance through the Health Insurance Marketplace?

Generally yes, as long as you qualify to use the Marketplace. Most people whose incomes are just above the level to qualify for Medicaid can pay very low premiums and out-of-pocket costs for private health insurance through the Marketplace. Find out if you’ll qualify for savings.

What if I’m eligible for Medicaid, but want to buy an insurance plan in the Marketplace instead?

A Marketplace insurance plan would cost more than Medicaid and usually wouldn’t offer more coverage or benefits. If you qualify for Medicaid, you aren’t eligible for savings on Marketplace insurance. You’d have to pay full price for a plan.

What if I have Medicaid now, but I have only limited benefits?

Some limited types of Medicaid coverage pay only for:

Family planning

Emergency Medicaid

Tuberculosis services

Outpatient hospital services

If you have limited Medicaid coverage, you can fill out an application through the Health Insurance Marketplace and find out if you qualify for comprehensive coverage through either Medicaid or a Marketplace insurance plan with savings based on your income.

Important: If you have limited Medicaid coverage, when you fill out a Marketplace application and are asked if you have coverage now, don’t check the box saying you have Medicaid. Check “None of the above” instead.

What rules apply to former foster children and Medicaid?

All states must offer former foster children uninterrupted Medicaid coverage until they turn 26, as long as at least one of the following is true:

They were in the foster care system and received Medicaid benefits on their 18th birthday

They aged out of the foster care system with Medicaid coverage after they were 18 or older

These rules apply after January 1, 2014.

Note: If the foster child moves to a new state, the new state’s Medicaid agency may not provide coverage. Check with your state Medicaid agency to learn more.

What if I’ve been turned down for Medicaid or CHIP coverage?

You may be able to buy a private health plan through the Marketplace instead. You may qualify for savings based on your income through a premium tax credit and savings on out-of-pocket costs. Many people can find plans for $75 or less per month.

In most cases, the state will send your information to the Marketplace. The Marketplace will send you a notice explaining how to submit an application for a private insurance plan. The application will be pre-filled with information you gave the state agency.

If your state hasn’t expanded Medicaid coverage

If your state hasn’t expanded Medicaid and your state agency said you’re not eligible under its current rules, you may have fewer options for coverage. Depending on your income you may not qualify for savings on a private insurance plan.

Medicaid Gross Income and Deductions Limits

Medicaid is a state-run program that helps people to afford their medical bills. There is more to determining eligibility for Medicaid than simply a person’s income. Only people with certain circumstances and who meet particular limits for their modified adjusted gross income will qualify for the program. The Affordable Care Act proposes to make amendments to these requirements in 2014.

Gross Income

The limits for an applicant’s gross income and assets are dependent upon the state in which he resides. Each state sets a level for the modified adjusted gross income of a person who wishes to qualify for Medicaid. Your modified adjusted gross income is your adjusted gross income, found on line 38 of Form 1040, plus additions for several tax deductions you previously subtracted to determine adjusted gross income. These deductions include: individual retirement account contributions, tuition and fees deduction, student loan interest deduction, foreign earned income that was excluded, adoption benefits deduction for the amount received from your employer and foreign housing deduction. Once you add these back to your adjusted gross income, you can determine whether you meet the modified adjusted gross income for your state. For many states, the modified adjusted gross income level begins at the federal poverty line.

Assets

In some states the amount of assets you own may affect your eligibility for Medicaid coverage. Assets include any retirement or saving accounts, savings bonds, your home, inheritances and any other type of security or property that could be exchanged for cash. The guidelines for how your assets will affect your eligibility depend on the state in which you reside.

Individual Limits

Individual circumstances aid in determining whether or not you are eligible to receive Medicaid, as it is not solely based on income and assets. Other determinants include whether you are pregnant or have children under the age of 18 who reside at home with you. The children do not necessarily have to be your own. If you are their legal guardian, you may still qualify. If you are over the age of 65, blind, disabled or terminally ill, you may also qualify. If any of the above situations apply and you are either leaving welfare or have existing medical bills you cannot pay, you may be approved as well.

Proposed Changes by the Affordable Care Act

The Affordable Care Act proposes to make changes that affect the eligibility of certain individuals for receiving Medicaid coverage. If put into effect, all individuals from ages 19 to 65 whose income is at or below 133 percent of the federal poverty level for the pertinent year will be eligible to receive Medicaid. The Act will also create a more simplified income test and streamline the enrollment process for applicants while allowing an individual to remain enrolled for up to 12 months if no changes in circumstances occur during that time period. The states will still largely govern and run their Medicaid programs, with the baseline eligilibility requirements set by the federal government. These changes are currently set to take place in 2014.

Medicaid and CHIP Eligibility Levels

CMS has worked with states to “convert” their Medicaid and CHIP eligibility levels to be based on modified adjusted gross income (MAGI) as required by the Affordable Care Act. Not all populations that are enrolled in Medicaid and CHIP will have their eligibility determined based on MAGI. The table below reflects eligibility levels in each state for key MAGI coverage groups, relative to the federal poverty guidelines, as of April 1, 2016.

State Medicaid and CHIP Income Eligibility Standards 1 (For selected MAGI Groups, based on state decisions as of June 1, 2016)

Note that this table reflects the principal but not all MAGI coverage groups. All income standards are expressed as a percentage of the federal poverty level (FPL). For the eligibility groups reflected in the table, an individual’s income, computed using the Modified Adjusted Gross Income (MAGI)-based income rules described in 42 CFR 435.603, is compared to the income standards identified in this table to determine if they are income eligible for Medicaid or CHIP. The MAGI-based rules generally include adjusting an individual’s income by an amount equivalent to 5% FPL disregard. Other eligibility criteria also apply, for example, with respect to citizenship, immigration status and residency.

States have the option to cover pregnant women under CHIP. This table does not include notations of states that have elected to provide CHIP coverage of unborn children from conception to birth.

Reflects Medicaid state plan coverage of the eligibility group for parents and other caretaker relatives. Parents and caretaker relatives with income over the income standard for coverage under this group may be eligible for coverage in the adult group in states that have expanded to cover the adult group. In states that use dollar amounts based on household size, rather than percentages of the FPL, to determine eligibility for paAdults with incomes between 133 and 200% of the FPL are covered through the Basic Health Programrents, we converted those amounts to a percentage of the FPL and selected the highest percentage to reflect the eligibility level for the group. States that actually use dollar amounts in making determinations are indicated by ($).

The dollar values that represent the FPLs in Alaska and Hawaii are higher than in the contiguous 48 states. For example, as of 2016, 100% of the FPL for a family of four is equal to $30,380 in Alaska and $27,950 in Hawaii, compared to $24,300 in the other 48 states and the District of Columbia.

The separate CHIP program in Arizona has been closed to new applicants and will begin new enrollment on September 1, 2016.

The separate CHIP program in California operates in three counties only.

The state has a section 1115 demonstration that provides Medicaid coverage to some additional low-income adults. The demonstration includes limitations on eligibility and/or benefits, is not offered to all residents of the state, and/or includes an enrollment cap.

Minnesota covers children up to age 2 with income up to 283% of the FPL.

Adults with incomes between 133 and 200% of the FPL are covered through the Basic Health Program.

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Eligibility

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.

In order to participate in Medicaid, federal law requires states to cover certain groups of individuals. Low income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community based services and children in foster care who are not otherwise eligible.

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133 percent of the federal poverty level (FPL) in every state (most states cover children to higher income levels) and states were given the option to extend eligibility to adults with income at or below 133 percent of the FPL. The majority of states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. Click here to see if your state has expanded Medicaid coverage to low-income adults.

Determining Eligibility for Medicaid

Financial Eligibility

The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost sharing reductions available through the health insurance marketplace. By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program.

MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent Children (AFDC) program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group, and does not allow for an asset or resource test.

Some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability or age (65 and older). Medicaid eligibility for individuals 65 and older or who have blindness or a disability is generally determined using the income methodologies of the supplemental security income (SSI) program administered by the Social Security Administration (some states, known as 209(b) states, use certain more restrictive eligibility criteria than SSI’s, but still largely apply SSI’s methodologies). Eligibility for the Medicare Savings Programs. through which Medicaid pays Medicare premiums, deductibles and/or coinsurance costs for beneficiaries eligible for both programs (often referred to as dual eligibles ) is determined using SSI methodologies.

Certain Medicaid eligibility groups do not require a determination of income by the Medicaid agency. This coverage may be based on enrollment in another program, such as SSI or the breast and cervical cancer treatment and prevention program. Children for whom an adoption assistance agreement is in effect under title IV-E of the Social Security Act are automatically eligible. Young adults, who meet the requirements for eligibility as a former foster care recipient, are also eligible at any income level..

Non-Financial Eligibility

To be eligible for Medicaid, individuals must also meet certain non-financial eligibility criteria. Medicaid beneficiaries must generally be residents of the state in which they are receiving Medicaid. They must either be citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.

Effective Date of Coverage

Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits may also be covered retroactively for up to 3 months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

Medically Needy

States have the option to establish a “medically needy program” for individuals with significant health needs whose income is too high to otherwise qualify for Medicaid under other eligibility groups. Medically needy individuals can still become eligible by “spending down” the amount of income that is above a particular state s medically needy income standard. Individuals spend down by incurring expenses for medical and remedial care for which they do not have health insurance. Once an individual’s incurred expenses exceed the difference between the individual’s income and the state’s medically needy income level (the “spenddown” amount), the person can be eligible for Medicaid. The Medicaid program then pays the cost of services that exceed what the individual had to incur in the way of expenses in order to become eligible.

In addition to states with medically needy programs, 209(b) states must also allow a spenddown to the income eligibility levels eligibility groups based on blindness, disability or age (65 and older), even if the state also has a medically needy program. Thirty-six states and the District of Columbia use spenddown programs, either as medically needy programs or as 209(b) states.

Related Topics

Spousal Impoverishment: Protects the spouse of a Medicaid applicant or beneficiary who needs coverage for long-term services and supports (LTSS), in either an institution or a home or other community-based setting, from becoming impoverished in order for the spouse in need of LTSS to attain Medicaid coverage for such services.

Treatment of Trusts: When an individual, their spouse, or anyone acting on the individual s behalf establishes a trust using at least some of the individual s funds, that trust can be considered available to the individual for purposes of determining eligibility for Medicaid.

Transfers of Assets for Less Than Fair Market Value: Medicaid beneficiaries who need LTSS will be denied LTSS coverage if they have transferred assets for less than fair market value during the five-year period preceding their Medicaid application. This rule applies when assets are transferred, sold, or gifted for less than they are worth by individuals (or their spouses) who need LTSS in a long-term care facility or wish to receive home and community-based waiver services.

Estate Recovery: State Medicaid programs must recover from a Medicaid enrollee s estate the cost of certain benefits paid on behalf of the enrollee, including nursing facility services, home and community-based services, and related hospital and prescription drug services. State Medicaid programs may recover for other Medicaid benefits, except for Medicare cost-sharing benefits paid on behalf of Medicare Savings Program beneficiaries.

Third Party Liability: Third Party Liability (TPL) refers to third parties who have a legal obligation to pay for part or all of the cost of medical services provided to a Medicaid beneficiary. Examples are other programs such as Medicare, or other health insurance the individual may have that covers at least some of the cost of the medical service. If a third party has such an obligation, Medicaid will only pay for that portion.

Waivers and Demonstrations: States can apply to the Centers for Medicare Medicaid Services for waivers to provide Medicaid to populations beyond what traditionally can be covered under the state plan. Some states have additional state only programs to provide medical assistance for certain low-income people who do not qualify for Medicaid. No federal funds are provided for state only programs.